Effects of an Emotional Restructuring Program on Psychological Functioning and Functional Capacity in Patients with Congestive Heart Failure

Congestive heart failure (CHF) has been associated with abnormalities in autonomic control of the cardiovascular system. In addition to physical decline, patients with CHF often report psychological symptoms such as depression, anxiety, and hostility. Psychological distress not only impairs quality of life but has also been linked to increased disease severity and mortality in CHF patients. Few studies, however, have investigated the impact of psychophysiological interventions in patients with CHF. This pilot study, conducted at the Stanford University, examined the impact of an emotional restructuring program on psychological functioning, functional capacity, and autonomic function in elderly CHF patients. Thirty-three patients (mean age = 66 ± 9 years) with NYHA Class I-III CHF were randomly assigned to a 10-week intervention program or a control group. The program included instruction in positive emotion refocusing and emotional restructuring techniques and heart rhythm feedback technology that have previously been shown to reduce sympathetic activation, increase parasympathetic activity, and improve psychological well-being in diverse populations. Self-report measures of psychological functioning, 24-hour heart rate variability (HRV) monitoring, and the Six-Minute Walk (a measure of functional capacity) were conducted pre and post intervention. After the program, the treatment group showed significant reductions in perceived stress, depression, and emotional distress and a significant increase in functional capacity. HRV increased slightly in the treatment group and declined slightly in the control group over the study period. This study suggests that training in positive emotion-focused techniques can improve psychological functioning and increase functional capacity in CHF patients in a brief period of time. Such brief, low-cost psychophysiological interventions may be a practical and effective means to augment the medical management of CHF.